Provider Demographics
NPI:1568691814
Name:VILLARREAL, JESUS ELEAZAR (MD)
Entity Type:Individual
Prefix:
First Name:JESUS
Middle Name:ELEAZAR
Last Name:VILLARREAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:910 SOUTH BRYAN RD. SUITE 202
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78572-4928
Mailing Address - Country:US
Mailing Address - Phone:956-682-6126
Mailing Address - Fax:956-580-0464
Practice Address - Street 1:910 S BRYAN RD STE 202
Practice Address - Street 2:
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78572-6659
Practice Address - Country:US
Practice Address - Phone:956-682-6126
Practice Address - Fax:956-580-0464
Is Sole Proprietor?:No
Enumeration Date:2009-07-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SCMD37023208600000X
TXQ4325208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery